Cervical Rotation Lateral Flexion Test

Special test of the Brachial Plexus

Authors
Affiliations

Nathaniel Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Purpose

  • This test is designed to assess 1st rib hypomobility as a cause of Brachialgia or thoracic outlet syndrome1
  • you should use this test for patients presenting with:
    • Brachialgia + thoracic outlet symptoms1

Technique

  • Patient seated with neutral head position in the sagittal plane1
  • Clinician then manually:
    • Put patient’s forehead in your C/L elbow
    • With your I/L hand, apply a downward pressure to patient’s I/L shoulder to prevent compensation (shoulder elevation)
    • Maximally rotates the C/S contralaterally (away from affected side)1
    • Flexes neck forward (ear to chest)1
  • Repeated on other side

Grading

1st rib mobility is assessed qualitatively by the clinician.

  • Abrupt restriction to passive moment indicates: 1st rib subluxation1
  • Unilateral restriction:
    • 1st rib mobilizations are performed1
    • pt is retested1

DDX

However it is worth remembering that a number of additional factors may influence the finding, including:

  • TOS1
  • cervical radiculopathy1
  • Upper thoracic pain1

Validity

Validity
Value Note
Interrater reliability Excellent1
Specificity N/A
Sensitivity N/A

Lindgren et al. found this test to have excellent interobserver repeatability and to have good agreement with a radiologic examination in the detection of a subluxed first rib.6

Clinical signifiance

CRLF is frequently used in clinical practice to determine whether a thrust manipulation targeting the 1st or 2nd rib should be performed, but Koppenhaver et al., found that the CRLF was not predictive of clinical improvement in neck pain following manual manipulations2

References

1.
Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 5th ed. McGraw Hill Education; 2020.
2.
Koppenhaver SL, Morel T, Dredge G, et al. The validity of the cervical rotation lateral flexion test in predicting benefit after manipulation treatment to the first and second rib. Musculoskeletal Science & Practice. 2022;62:102629. doi:10.1016/j.msksp.2022.102629

Citation

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